Diabetes Support at School

Starting a Group

I am a firm believer that groups can make all things fun, not just bearable. In almost 20 years of school guidance counseling, I’ve had kids in support groups laughing even when dealing with such heavy topics as grief and divorce. Over the last three years I have developed and led a support group of middle school students who have Type 1 diabetes. And they have been grinning, snickering, and laughing out loud!

If your school or community does not offer a support group for teens with diabetes, perhaps you need only to ask for one. That’s what happened in my case. A parent of a recently diagnosed child commented to the school nurse, in my presence, that she wished there were a support group somewhere for such kids. Knowing next to nothing about Type 1 diabetes, I stepped up.

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How do you initiate such a group at your child’s school? First, you need to contact a guidance counselor or the school nurse to find out if there are enough students with Type 1 diabetes to form a group; an effective group needs at least four members. (The same general approach would likely work well for a group of students with Type 2 diabetes, although you might need to alter some of the activities suggested here.) Then you need to ask the counselor to consider becoming its leader. Emphasize the emotional and social benefits of having such a group. Point out that a group will help students realize they are not alone in coping with this condition, and that group members will form a close bond with each other as they express feelings that only others with diabetes can fully understand. In a group setting, they can learn from each other’s mistakes, discuss uncomfortable situations that arise, and buoy one another with hope. It should be hard for the counselor to ignore your plea, especially if you come equipped with a suggested group agenda (such as a copy of this article)!

Getting started

Any school counselor interested in starting a diabetes group in a school should obtain a list of diagnosed students from the school nurse, since the nurse is the primary staff member closely connected to these students. The counselor should then draft a letter to the students explaining the proposed group, including an agenda of topics to be covered, if possible.

No meetings should be conducted with the students before parents are contacted. Some families may have reservations about a counselor talking with their children about a private health condition, but most will be pleased that someone is recognizing their special concerns. So far I have had 100% participation. Parents have been not merely agreeable, but enthusiastic.

Though my focus is middle school, these group sessions could easily be adapted for elementary school. The nature of this kind of group calls for a yearlong schedule: It’s not as if the students’ diabetes will disappear for part of the year. Also, since the group will most likely be composed of students from several grade levels, practical scheduling may limit meeting times to the first or last period of the day. For this reason, I meet with my group on a monthly rather than weekly basis throughout the school year. With meetings spaced far apart, the first- and last-period teachers rarely complain about the students missing their classes.

A group leader will most likely find that the months don’t roll around fast enough for students in the group. Most kids with Type 1 diabetes have never before had the opportunity to be in such a setting, and they are elated to have their situation acknowledged. Add to that the opportunity to miss class once a month, and the diagnosis has suddenly taken on a positive aura.

I invited the school nurse to be a part of our group, and she joins us when no “emergencies” are parked at her door. The relationship of a child with diabetes (or another chronic condition) with the school nurse – if there is one – is of paramount importance. In a support group, the nurse can learn about the multifaceted lives of these students, something beyond the daily accounting of numbers.

Initial session

At the first session, the group leader can begin by covering general information about the support group. Rules are necessary but should be few in number. Some acceptable rules are listening respectfully to others, not monopolizing the discussion, and only laughing with someone as opposed to laughing at him. The importance of confidentiality should be explained. It is a good idea to go over the schedule thoroughly, ensuring that the students understand proper procedures for leaving and reentering classes. Placing reminder notes in teachers’ mailboxes on the days of group meetings may be essential for students to show up without being chased down. Yes, they want to be with the group, but it’s amazing how often adolescents can forget.

After the leader has covered the basics, the group can move on to a great conversation starter: a sentence-completion activity. Before the meeting, the leader should write unfinished sentences about diabetes on a piece of paper, cut the paper into strips so there’s one sentence per strip, and place the strips in a basket. When the group is ready, pass the basket and have each child draw a strip. Students should be allowed to pass or redraw if they do not feel comfortable finishing the sentence on their slip. Here are some examples of what to write:

I want to tell my friends who don’t have diabetes that…

When I see my parents upset about my diabetes, I feel…

It is important to take as much time as needed for this activity, allowing students to elaborate on their own statements and those of others. They may be new to each other and a bit timid at this first session. At first the older students may tend to dominate the younger ones, and the leader will need to take over the reins if this happens.

Challenge of the day

Starting with the second session, it may be desirable to begin each meeting with a “challenge of the day.” This can be related to the meeting’s main topic or tied to the season. A timely issue to discuss in October is Halloween: how students handle the candy bombardment. They may give answers such as, “My dad buys my candy from me by the piece, so I make a lot of money!” “I have fun dressing up and handing it out at the door,” or, “I like to give it to my friends.”

Other possible “challenge of the day” topics are field trips, swimming pool events, sleepovers, and even something as general as the amount of time spent each day checking blood glucose levels.

School life

An ideal main focus for one of your meetings is how having diabetes affects school life. After all, school is of supreme importance to adolescents; they will have a lot to say. The leader should make sure group members understand their right to check blood glucose levels at school and to see the nurse any time they need to. They can be asked how they feel about having to miss part of class to check in with the nurse. How do they catch up in class? How do episodes of high or low blood glucose affect their grades? What are the pros and cons of being separated from others or having other modifications during standardized tests? What worries them most about school?

Food scenarios

Another good topic for the group to discuss is how food is at the center of many school (and other) events, and how to deal with these situations in a healthy manner. The group leader can distribute a worksheet that describes typical situations teens find themselves in during or after school hours, with options for how to act in each situation. Students should select the best choice for each (and maybe also note how they probably would really act). The group can do this together, with the leader asking who chose A, B, C, or D. Students can share an additional answer (E?) if they think of an alternative solution. Here’s an example:

Jonathan’s chess club always has snacks during the meeting. Students take turns providing refreshments, and most bring regular sodas and high-calorie sweets. Jonathan should (A) eat nothing and sulk, (B) eat some of it if he’s hungry and cover the carbohydrate he consumes with insulin, (C) bring his own snacks, or (D) when it’s his turn, bring in healthy snacks.

Home life

At another session, the group can talk about how having diabetes affects their lives at home. To stimulate discussion, the leader should write the word “activities” on half a dozen narrow strips of the same color of paper, the word “siblings” on six more, and the words “food” and “money” on six more each, as well. A different color should be used for each category. With all of the strips in a basket, each student must then draw a strip and tell how having diabetes affects that particular aspect of his home life. For example, if a student pulls a strip labeled “money,” he should describe an incident or something in general about how his diabetes affects family finances. He may reveal that he has overheard his mother complain about the cost of insulin, or that his family is saving money for a pump.

To raise the chances that all the different topics will get discussed, the leader should not tell students during the first round that the colors of the strips mean anything. After the first round, however, students can be told that all yellow strips are about money, all blue ones are about food, etc. Then in subsequent rounds they can exercise choice in selecting the area they want to discuss. With the strip labeled “food,” students may talk about not always being able to eat what everyone else in the family is having for dinner, or about the trouble their mothers go to just to cook something special for them. With the strip labeled “activities,” there may be responses about the whole family canceling plans when the student has an episode of low blood glucose. The strip labeled “siblings” can be expected to stir up some anger: Students may report on siblings who taunt them while snacking on candy bars or who scream in jealousy over all the attention the sibling with diabetes gets. This activity sparks both laughter and shared frustration, and helps bond the students even closer.

“Live-abetes”

For the January session of the group, I suggest not talking about diabetes. The leader should place a sign on the door of the room that says “Live-abetes” and tell the students they cannot utter the word “diabetes” during the entire session. If someone says the “d” word, there can be a silly punishment, like running a lap around the table or singing a solo.

Since January is a time of beginnings, this session will emphasize the value of focusing on the many other aspects of life. The students can do this by making a collage. For this, the group leader should cut out magazine pictures ahead of time and lay them out on a table. Students can then select pictures that they think represent them both now and how they’d like to be in the future. Once they have completed their collages, each should share the reasons for his choice of pictures. At the end of the year, when the students complete evaluation forms, many may choose this session as their favorite – they are given permission to see themselves, and encourage others to see them, as someone other than “that diabetic kid.”

Advances in medicine

At another session, the group leader may want to talk about what is on the horizon in the medical field; it’s hard to talk about diabetes without mentioning the research that brings hope to so many. A reputable website such as the American Diabetes Association (www.diabetes.org) or the Juvenile Diabetes Research Foundation International (www.jdrf.org) can provide appropriate information to share. It is a good idea to caution the students about claims of cures, assuring them that their doctors will know when something helpful has been approved. Let them imagine some funny cures, and they’ll laugh themselves silly. What if doctors find out that green M&M’s are the magic bullet? What if a mixture of chopped caterpillars and birdseed is the cure – would you eat it?

Guest speaker

Another idea for a session is to invite a guest speaker, ideally an older teenager who is coping successfully with diabetes. The school nurse may be able to contact the nurse at a nearby high school to recommend a student who is thriving (the idea, of course, is to generate a positive influence). It’s advisable to schedule this meeting at the end of the school day for the convenience of the high school student. With college students, it may be necessary to schedule the meeting when they are on spring or winter break. If there are transportation problems, perhaps a school counselor or nurse can fetch the student.

It’s wise to prepare some questions together at the previous meeting that group members can ask in case they suddenly freeze up. As usual, the leader can write the questions, cut them into strips, and throw them into that faithful basket for group members to draw from. Here are some examples of questions students may wish to ask:

How does diabetes affect driving and obtaining your driver’s license?

How does it affect dating?

Do your parents still bother you with questions about your blood sugar?

Attitude scenarios

By midyear the students will know each other and the group leader well. It’s a safe time to talk about choosing the attitude that they will carry through all of the special situations they find themselves in. The group leader can write scenarios on – you guessed it – strips of paper, and pass the basket. Here are some ideas for possible scenarios:

Maria did not do her homework because she was watching Monday night football instead. She tells her teacher that her diabetes was acting up last night.

Shane is having a rough day with his diabetes. He has ketones and must go home from school. A classmate says, “Lucky you. You get to go home.”

There won’t be a pause of two seconds before discussion erupts! Some members of the group will recognize themselves in these scenarios and openly admit to exhibiting negative attitudes at times. It’s all right for the students to freely express themselves and to chide one another, but the leader should keep it from becoming vindictive.

JDRF activities

Each year the JDRF organizes a variety of awareness and fund-raising activities, including walk-a-thons in hundreds of U.S. cities. If your school gets involved in any of these activities it’s a great time to promote the positive side of being “special” for students with diabetes. Perhaps they can be included as speakers on school video announcements or at assemblies – if they want to be, of course. Or the support group could perform a skit at a diabetes-themed event. If a JDRF walk is being held in your town, this can also become a group project. Even if only a few students participate, it is still a great way to lift up the cause.

Life-size board game

One of the most fun sessions (best saved for near the end of the school year) involves playing a simple game in which group members step toward or away from a finish line according to directions drawn from that well-used basket. First, the group leader lays out ten large pieces of construction paper in a line on the floor. This should be done outside if the school has a courtyard or sidewalk that is not heavily trafficked.

Each student then takes a turn by drawing a slip from the basket. Once everyone has had a turn, the same order is cycled through again until someone reaches the finish line.

Here are some examples of instructions to write on the slips:

You don’t tell your mom when you run out of snacks at school. Go back 1 space.

There can also be a number of “free space” strips; this means a free step forward. If the group uses up all the strips before someone has reached the final space, the strips can simply be put back into the basket and recycled.

End of the school year

The final meeting of the school year should feature a brief review of topics covered during the year. Since it will soon be vacation time, it may also be good to have a discussion about important considerations for traveling with diabetes. Topics to note include how time changes and flight schedules can make handling diabetes problematic, and how being out of a regular routine – such as during a long day at the beach – merits close attention to blood glucose levels. Also, students may have grown accustomed to having a nurse nearby for much of the day while in school, and they will now have to depend on themselves or on parents to manage their diabetes.

Finally, at this meeting the group leader should distribute an evaluation form. It should ask the students what they liked about the group, what they would change, what their favorite session was, and other pertinent information. This input can then be used to tailor sessions for the next year, so that when the students come back, they continue to be motivated by fun, thoughtful activities. This is only fair, given the humor, sincerity, and love that they will bring to the group.

Take action

If you are a parent of a child with diabetes and his school has no support group, don’t hesitate to show this article to the school counselor. Any counselor who has graduated from an accredited counseling program will have been required to study group work, including group dynamics, leadership, and group counseling theories and methods, as well as work directly with students in a small group activity as part of their education. (The accrediting body for such counseling programs is the Council for Accreditation of Counseling and Related Educational Programs, or CACREP). If the counselor has also had some previous experience leading support groups, so much the better. And if you’re concerned that the counselor doesn’t know much about diabetes, provide some help in this area by pointing the counselor toward some authoritative sources of information such as the JDRF or the American Diabetes Association.

If you are a school counselor who has been asked to start such a group, consider the immense benefit that a support group will give to students with diabetes. You have been provided with a plan in this article, and of course you can use your imagination to expand upon the activities or create new ones. Start a group and watch it take off! You’ll have no regrets.

Debra Madaris Efird is a counselor at C. C. Griffin Middle School in Concord, North Carolina. She has led a Type 1 diabetes support group at her school for several years.

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